Paramedics experiences and expectations concerning advance directives: A prospective, questionnaire-based, bi-centre study
Palliative Medicine, 08/31/2011
Taghavi M et al.
– Decision making in prehospital end-of-life care is a challenge for all paramedics. The present investigation demonstrates that a dialogue bridging emergency medical and palliative care issues is necessary. The paramedics indicated that improved guidelines on end-of-life decisions and the termination of cardiopulmonary resuscitation in palliative care patients may be essential. Participants do not feel adequately trained in end-of-life care and the content of advance directives. Other recent studies have also demonstrated that there is a need for training curricula in end-of-life care for paramedics.
Questionnaire-based investigation using self-administered survey instrument
Paramedics of two cities (Hamburg and Goettingen, Germany) were included
Participants were questioned as to (1) their attitudes about advance directives, (2) their clinical experiences in connection with end-of-life situations (e.g. resuscitation), (3) their suggestions in regard to advance directives, ‘Do not attempt resuscitation’ orders and palliative crisis cards
Questionnaires were returned by 728 paramedics (response rate: 81%)
Majority of paramedics (71%) had dealt with advance directives and end-of-life decisions in emergency situations
Most participants (84%) found that cardiopulmonary resuscitation in end-of-life patients is not useful and 75% stated that they would withhold cardiopulmonary resuscitation in the case of legal possibility
More extensive discussion of legal aspects concerning advance directives should be included in paramedic training curricula
Palliative crisis cards should be integrated into end-of-life care
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